You Need Rest, Doctor!

Before we get to today’s post, I want to recognize our friends and colleagues in Texas and Louisiana who are living the nightmare that is the aftermath of Hurricane Harvey. Thank you to everyone who has made a tremendous sacrifice, and I hope your lives and homes can be put back together when the flooding subsides.

Occasionally, I like to remind my readers that this site has a charitable mission, and I can’t imagine a better time to put it to good use. Last night, I donated $1,000 to charities with boots on the ground helping victims of the natural disaster. I know there are many more worthy charities, and I encourage you to give to the charity of your choice. Recipients of this site’s charitable giving this week are:

By using our Fidelity Charitable Donor Advised Fund (DAF), I was able to find the five charities, input my donation, and approve the grants in about five minutes. It’s incredibly time-efficient way to give to a broad swath of charities, not to mention the tax-efficiency of giving via a DAF.

Want to help me give more? Sign up for Personal Capital via my link and track more than $100,000 and I’ll be notified. I normally donate half my profits, but over the next 7 days, I’ll donate 100% of my referral fees from them, and will update you in the September 9th Sunday Best. If you’ve been on the fence about using the service, there’s no time like the present.

Today’s guest post comes courtesy of a prolific physician personal finance blogger known simply as the Wealthy Doc. His website of the same name has been around in some form for the better part of a decade, and he has been sharing his wisdom on life, money, and medicine via the site.

His posts have been featured here on the Student Loan Resource Page and in The Sunday Best. Highlighted posts include:

You Need Rest!

If you are a high-income professional, and especially if you are practicing physician, you need rest.

Why do I say this? Because you have gone through an enculturation process which focuses on hyperactivity and super high-level achievement. In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the least.

This may be especially true for older doctors who trained in a prior era, but it is still true for most of us. Calling in sick or going home early was a sign of inexcusable weakness when I trained. That has been deeply ingrained into my being.

I recently read an entire book about rest. If the importance of rest is not clear to you or if you find yourself struggling to obtain rest in your life I recommend reading that book. It is evidence-based and very well written. For those who are unable to read the book, I will summarize here some of its points.

Work and rest are two sides of the same coin. Like day and night, you cannot have one without the other. Like the peak and trough of a wave they have no meaning in isolation, but only relative to each other.

Likewise, we tend to be obsessed with either work or rest as though it is an all-or-none binary position. Work may consume every waking hour of our life. It then takes over every aspect and drives us to burn out.

At that point, we dream of retirement. Our dream and vision of retirement may be a complete and total cessation of work so that our days are filled with rest or leisure only. Either extreme is not conducive to optimal living.

Rest Should be Scheduled

Rest should not be an afterthought. It is not just a passive void to be filled in when there’s nothing else to do. Rest does not just appear on its own in sufficient quantities. No one will give you the amount of rest that you need for optimal living. You need to take the bull by the horns and plan rest and schedule rest and make rest a priority.

Rest will make you more productive. The reason to rest should not be solely based on increased productivity. Nevertheless, there is significant research and anecdotal experience that shows those who can take enough rest are more productive in their work hours. This was seen on a large scale when mandatory overtime was required in manufacturing firms. Productivity per work hour suffered markedly because the employees became exhausted and disengaged.

Rest fosters creativity. To become world-class. To become a genius. To create a new infrastructure or paradigm requires a well-rested active body and mind.

One survey showed that the most productive world-class performers are more likely to consider themselves lazy than to consider themselves ambitious. Part of the reason is that they schedule non-work activities. This is not only a distraction from the work. It allows a different mode of thinking. Instead of focused thinking it induces diffuse thinking – which better lends itself to creativity.

It is not a coincidence that a discoverer of DNA, James Watson, enjoyed an active life of leisure, dating, and skiing. Some of his best ideas came while relaxing on the slopes or while browsing in a bookstore.

Steven jobs had his most successful meetings and ideas while going on long walks. There is a strong link between the creativity level of theoretical physicists and their consistent predilection to hiking and mountain climbing. In what ways could you use more creativity in your life?

Rest as a Skill

Part of rest is scheduling adequate sleep. Americans live in a hyperactive, sleep-deprived world. It seems to be something to brag about. How few hours of sleep can you get by on? An increasing body of literature is demonstrating harm to psychological well-being as well as physical well-being due to sleep deprivation.

Chronic sleep deprivation affects mood and job satisfaction as well as intellectual performance. An adequate sleep schedule does not just occur on its own without planning. It takes effort to carve out this important time.

Rest should be active, not passive. The most effective restorative rest that counterbalances long and stressful work hours comes from active leisure. Passive activities such as mindless TV viewing can allow a brief break after a busy day but it does not have the restorative capacity to truly counteract work in the way active leisure does.

How could we better reconnect to our childhood pleasures? Did you used to like running? Or tennis? Or playing kickball? Or climbing a wall? Incorporating some of those activities in a normal adult life can lead to a healthier psychological and physical disposition.

Rest is a skill. Like any skill it takes training and effort to improve. Have you heard of deliberate practice? Think in terms of deliberate rest. Most of us have not been trained in improving the skill of rest or understanding its true importance with regards to creating a whole and meaningful life.

Fighting Burnout with Rest

We may need to learn how to prioritize, set limits, say no, and plan our “office work” hours. I have had to learn the skills of letting go and disconnecting.

I achieved some milestones:

I took a 2 ½ week summer vacation.

I took a few Wednesdays off in one month.

I had a practice partner cover my in basket in my EMR while I was away.

I turned on the auto responder on my email noting I was out of the office.

These were difficult habits to break or establish. At first I felt like I was dumping on my partners and abandoning my patients. As time goes on, I am much more comfortable with being disconnected and enjoying the non-work aspects of my existence. I highly recommend incorporating more time with each patient, shorter work hours, and true time off to disconnect from everything work-related. It is restorative.

None of This is New

Rest is not a new concept. Although we may think that our obsession with busyness and our interaction with technology is a new phenomenon, it is not. The ancient Greeks and Romans argued that you cannot have a good life without good work and without good rest.

Technological innovation is also not new. The revolution in travel, manufacturing, mobility, railroads, telephone communication, etc. were at least as disruptive as our current instant messaging and social media technology.

Physician burnout is not new. There is a growing body of literature and research in physician burnout. One very early neurosurgeon, Wilder Penfield, warned medical students that unless they cultivated other interests -other than their specialty- an “insidious disease” would enter them and imprison them in lonely solitude.

He felt that the subspecialty focus would make them isolated and not connected to other important things in life.

Penfield’s mentor, William Osler, warned that without care, “good men are ruined by success in practice.” He also warned that the “ever-increasing demands” can leave even the most curious person “worn out, yet not able to rest.”

Have you ever heard a more apt description of physician burnout? I have not. Osler also felt it was essential to develop “some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters.”

The challenge we face when learning to rest better is not to avoid work, but to discover how to create a better fit between our work and our rest. If you enjoyed this, you would love Alex Soojung-Kim Pang’s book on this important subject of rest.

Open your own DAF with Fidelity Charitable ($5,000 to start) by clicking on the image below and be sure to let me know if you do. Or help me give more by using the Personal Capital link below to sign up for their free investment tracking and analysis service.

50 comments

I agree completely. Unfortunately, work as a physician often involves minimal control over our work hours, type of patients seen, number of patients seen, time with each patient, and amount of vacation time. If you can find a way to gain that control in your practice, then forget early retirement; you’ve already reached the holy grail.

I think a lot of physicians feel trapped. I have a couple thoughts: 1. We are more powerful than we think we are. I have spent a fair amount of time “on the dark side” in administration. Doctors are more valuable than you realize. They know you can’t run a hospital or health system without good doctors. You get not what you deserve, but what you negotiate. Look around for some flexibility options and they may be there or up for discussion at contract renewal time. 2. If truly every aspect of your work is fixed and out of your control for ever (again I’m skeptical that this is true) then it is all the more important to develop the skill of active leisure and schedule it. Stress is fine as long as it is counterbalanced with active leisure and rest. 3. Finally, mini-breaks during the day can rejuvenate. Could you take ten slow deep breaths and get centered? Could you step outside between cases and feel the warm sun on your face and listen to the chirping birds? Even tiny snippets of pleasure can renew.

I’m a huge fan of rest. I try to get in bed by 10 pm and up by 6 am everyday. Getting 8 hours of sleep is huge for me. On top of that I make sure that my wife and I take regular get aways so that we can recharge. Otherwise I quickly feel like I get burned out and feel drained. Great post!!!

Mustard Seed Money, Glad you liked it. That is a great routine you have established. It is a rare person who does that but I think it is important. Especially if it includes 8 hours of sleep. Tim Ferriss (‘hack expert’ “efficiency/productivity expert” and author/podcast creator) was asked how he minimizes his sleep. He responded no way, I sleep a lot. Being well rested is one of his key factors to mood and productivity. I agree. I could do a better job of scheduling get-aways for me and my wife. We have done a few, but not enough. You are wise to listen to your body and realize when burnout is creeping in. And then take action to prevent it. Too many of us try to ignore the early signs. Later, the symptoms are too overwhelming to be tackled.

I totally agree that rest is something you HAVE to do and HAVE to plan for. I prefer to schedule out some personal days at work in order to make sure I take a step away from everything every so often.

And thank you for donating to the efforts in Houston. As a Dallas resident, I can tell you the stories of friends and family’s losing everything is horrible. I’ve seen far too many videos and pictures of people I know and their family’s in incredibly difficult situations. Another great company to donate to is H-E-B. For those of you not in Texas, H-E-B is a grocery store that is generally the first company to respond to disasters. They provide anything they can that comes through their stores – from food, water, toiletries – among many other things. They have a fund and they do great things. Here’s the link –> https://www.heb.com/static-page/Disaster-Relief?_requestid=529886

Lance, I only recently got smart enough to schedule out some personal days. I usually sprinkle a few through each quarter. I then forget about them. When they come up it is a pleasant surprise. I try to keep the schedule blank for those days and I can do whatever I want. The mini-breaks are wonderful. And yes, here’s to PoF for the mention and for doing what he can to help. And to you for the information on another possible charity. I pray for the people of Houston.

When I think of “rest,” I usually imagine a lack of physical and mental activity, such as lounging around the house in my PJs or sleeping. But I like how your definition of rest includes physically and mentally stimulating activities that differ from your typical work. For example, I typically find a long run much more useful to my mental state than an equivalent-length nap, and exercise often helps me sort out some of the jumbled thoughts that accumulate during the week.

It seems “rest” could be anything that one wants to do, rather than feels obligated to do.

p.s. I’m looking forward to some actual rest when my 2-month-old starts to sleep through the night 🙂

Dr. Curious You bring up a good point. Rest does include what you describe as well. When you are busy and worn out and over-scheduled there is nothing wrong with taking some time to chill and recover. For me that may mean sleeping in, sipping hot green tea, reading the Sunday NYT, petting my cat, and going for a stroll. It may be something different for others. But it also includes active leisure – especially if there is a big block of time. Passive TV viewing isn’t enough -by itself- to fully rejuvenate a vibrant soul.

Between work and kids I struggle with the sleep aspect of relax. I can’t wait for the point when my kids can wake up and self entertain on the weekends. Until then not sure there is much to be done. I do recognize in me the mood and performance impacts though.

FullTimeFinance, I hear you on that one. My kids are older now and I’m still waiting for them to be able to self-entertain! We sometimes threaten them to stay in their rooms if they wake up early. Do not even think of making noise or waking us up until ___ time. It doesn’t always work, but it helps some. I also resigned to going to bed very early. I need a lot of sleep. I can go without it for a few days or even a week or two, but it then catches up with me. The result is I put the kids to bed and then I follow shortly after. I would like more of a “gap” to enjoy time after the kids go to bed, but I know I feel and perform best when well-rested and mornings come early – like it or not.

The sleep part is a challenge with young kids and / or a Doctor job. Being chronically sleep deprived is a tough way to live, but it’s a fact of life for many young mothers, fathers, and people on call of all ages!

I’m a huge believer in taking all the vacation time you have coming to you. I can’t believe all the statistics about how many vacation days go unused. We are so hustle oriented, but I think we can be even more efficient and effective when we work, if we get proper and periodic R&R.

Barnaby, Good for you! I only recently got it through my thick skull (with my wife’s prompting) that PTO/Vacation days were meant to be used. I was trained old-school. I am learning more about life balance from my younger partners. I now use all the days available and it feels wonderful. Even for those who are achievement-oriented may find they can produce more over a year if there are breaks interspersed. This was written about in The Power of Full Engagement, by Jim Loehr and Tony Schwarz. The tennis champs who performed the best had the most rest. They even took mini rest breaks during a game or between sets. They were masters of recovery.

DDD, I’m kind of like that too. I was a night owl by nature. I transformed myself into an early bird to be able to produce with the rest of the world. Now I wake up at 6 or before even when I don’t have to. Part of that is because I consistently go to bed early though. Boring life – but I’m in a good mood and productive!

As a recently recovered burnout physician (single partner left without resignation in 3 doc practice) this post is excellent. You feel weak and defeated when burnout hits, but it’s real and the extra money don’t matter a bit. I would give back half or more of what I made during that time to have optimal mental health.

You are right about physicians having more power than we think. Administration doesn’t like us to know this (sometimes). But I don’t recall the last dollar someone other than me generated, especially administration. So I leveraged this when I was alone, got a half day off, locums and no more double/triple booking.

I also enjoyed your 34 items post a few months ago. I got the Headspace app, all I can say is “yuge”.

I reached financial independence during my burnout phase and it empowered me tremendously to demand what I need for mental health. Compassion fatigue exists, and I wont do it again. When I teach students, I preach work-life balance. They skirt the issue (head nods and uh huhs while texting) just like I did when I was younger, but I’m relentless on the subject. It’s one of those “if I knew then what I know now” things.

aGoodLifeMD, Wow. Great points! You should write your own guest post about some of that. My brief responses: 1. I agree that Time is more valuable than Money. Especially when you are heading to burnout. 2. I’m glad to hear you see some of the hidden power that doctors have when negotiating. I think your statement: “So I leveraged this when I was alone, got a half day off, locums and no more double/triple booking.” will be inspiring to others who feel trapped. 3. I have read a lot of books about meditation. And tried a lot of CDs, recordings, visualization methods etc. For some reason, HeadSpace really is so much better than all the other options – at least for me. I find it easy to use and his voice is clear yet soothing. He is the real deal too: an actual former Buddhist monk. 4. Congrats on achieving FI. Isn’t it wonderful?! It is hard to describe to others just how liberating it can be. I commend you on teaching (or trying?) the younger doctors who desperately need to hear these things. You can only do so much if they aren’t ready to hear it though.

I don’t think any books are needed if you have the app. It is more a matter of doing rather than knowing. It mostly comes down to carving out the time, being able to sit, and focusing on breath or a simple visualization for a few minutes. It is simple, but not easy.

THANK YOU for donating to Austin Pets Alive!!! I’ve worked with their San Antonio equivalent (SAPA) and they really do amazing work. So many animals were displaced or harmed after the hurricane and they’re really making a difference.

Good for you! I saw the charity come up in several of the articles I read about how to best help from a distance. We donate to our local no-kill shelter annually, so I thought that would be a nice addition to our giving.

How did that feel? I know after my 2.5 week vacation this summer I said, “It might be my first, but it won’t be my last!” It takes me a week just to detox and feel human again. The second week I can actually enjoy myself.

Really great article and lots of pearls to incorporate into my routines, especially as I battle against burnout and consider my impending part time schedule and likely glide toward retirement from practice.

Thank you, too, to PoF, for being a good role model for charitable contribution to help the people (and pets) in Texas in their time of need.

Glad you liked it, Vagabond. I’m hoping you go to part time soon and can really enjoy life again. Sometime doing just a little less feels great. I love drinking water, but drinking from a fire hose? Not so much.

I agree with your comment on PoF. I can’t be in Houston to help out, but I sure can provide support to those who do. I have a DAF as well, but it didn’t occur to me to send money to TX until he wrote that. Now my wife and I are determined to help somehow.

Some people feel you shouldn’t flaunt your giving, and I can understand the perspective, but I’ve found that by sharing my charitable giving via the site, I motivate and inspire more to give, magnifying the benefit of the gift.

As a medical student, I always made it a priority to take Sundays off of studying to do household tasks and visit my family, and I think it made me far happier and more productive than my classmates who tried to study seven days a week. People can only do so much before the body and mind shut down and demand that we rest, and we do ourselves a disservice to try to push ourselves too hard.

As a relatively new practicing physician, I also try to make lots of time for rest, but I find it can be hard to deal with the reactions of colleagues. I am trying to get into the habit of taking a vacation every three months (for a total of 5-6 weeks vacation time per year, including Christmas), and people will often make comments about how “you’re on vacation again”. This is despite the fact that my time off doesn’t affect anyone else adversely – I do as much call as anyone else in my group, I have busy full clinics when I am working, and I am fee-for-service, so I get paid based on how much I work. But I still push ahead with the vacations, because I find that I am much happier when I know that a break is never more than three months away.

Solitary Diner (although you aren’t solitary anymore, right?) I think Modern Americans are rediscovering the Sabbath. Perhaps it isn’t a silly antiquated idea after-all? I love that you were able to do that during Medical School. Good for you! I think you are on track with taking a break each quarter. When people say you are on “vacation AGAIN?” smile and say, “Yes I was!” with enthusiasm. A medical career and all its associated players on the stage are more than happy to grind you down with 14 hour days 7 days a week if you let them. I know it is hard, but try not to let the guilt trip change your plan. It is normal to feel bad or guilty at times, just don’t cancel your breaks. You know you need them!

I have been pushing rest, both as sleep and time off, in my Doctors Guide book series and my videos on YouTube. I practiced what I preached. I took the day off after a three day weekend of call. I took one day off during the week. I went on 8-13 weeks of vacation each year. Most years I took a 3 week vacation in the summer.

Yet, as I stated on my blog recently in a piece titled, “What I Learned in the First Six Months of Retirement,” I was still suffering from chronic sleep deprivation. I did not realize this until several months after ending my clinical practice. I always just thought I was not a morning person. My wife was always up before me and I had a hard time getting going each morning.

Now, 6 months after drop kicking my pager through the goal posts of life, I wake up an hour before my wife does almost every morning. I wake without an alarm almost every day now, yet I am up early and ready to go.

One of my statements on assessing rest is this: If you need a cup of coffee to get you started in the morning, you are not getting enough sleep. If this is true for you, start going to bed an hour earlier every night until you no longer need the coffee to get you started in the morning.

Coffee is pretty prevalent in America. Is that because Americans in general don’t get enough sleep? High performers (doctors) are probably at the top of the sleep deprived list.

Thanks for sharing your experience, Dr. Fawcett. That is fascinating. You are getting up earlier now that you are retired. Amazing! Do you go to bed before your wife too? My wife and I both need a lot of sleep, so at least we are on the same page there. I always fought my need for a lot of sleep. I thought it was just my “lazy” tendency. I powered through with exhaustion, naps, and tons of coffee. I’m more aware and kinder to myself now.

Yes, I get up earlier and more refreshed now that I have retired from medicine.

I suspect the biggest issue was the loss of REM sleep. Getting interrupted at night with pager blasts and phone calls messes up the sleep pattern. Now that that doesn’t happen, I seem much more rested. People have actually made that comment to me.

My wife and I almost always go to bed together. Overall she tends to sleep a little longer than me now. Our tendency is to do things together. We go to bed together, eat dinner together, travel together and exercise together. She also went with me on every locums assignment, something I did during the last three years of my practice.

Wealthy Doc, I have something I would like to discuss with you privately. Can you get in touch. I can be reached at drcorysfawcett (at) gmail (dot) com.

TheHappyPhilosopher, I agree. Can you imagine any of your attendings pontificating on the importance of leisure? Teaching the interns how to just relax and do nothing? HaHa. Right! It is not consistent with the Medical Culture. Things are slowly changing though.

My wife and I have started going out of our way to schedule “date nights” (or days), which we hadn’t done in a planned manner since having kid #3 a year ago. We also just completed a 1-week trip to the UK w/o any of the 3 kids — it was phenomenal.

After a year of not exercising (kid #3 sorta threw us for a loop for many reasons) I’ve started scheduling time in the gym in advance so I can go. Because of my random ER/research/admin schedule I have time at home already and block mornings/afternoons or even entire days where I am by myself. I’m usually working from home those days (not goofing off), but it’s still way more relaxing than being in my office or in the ER.

I still shortchange myself on sleep, but the kids are partly to blame for that. I already lose sleep from evening/overnight shifts, and there’s a 50% chance any given night one of the 3 kids will wake us up… I’m also to blame for it though since I’m a night owl and when they go to bed I like to have alone team to goof off, since my alone time during the day is usually working.

Thanks for sharing that, RogueDad. I have many of the same struggles. A few date nights now and then can really keep a marriage strong I’ve found. That is important for personal and financial reasons! I find unless I exercise first thing in the morning, I tend to put it off or avoid it. I know what you mean about alone time too. I’m an introvert. My medical job is very demanding and draining at times between patients, their family, my staff, colleagues, etc. Then I have a full house at home – wife and kids. Even an attention-starved cat. I need a little time each day for solitude to keep my sanity. I meditate for 10 min in the morning (HeadSpace) and then read for about 20 min before bed. That way I at least have 30 min for deep solitary time. I grab more if I can get it – but that is the minimum.

I agree. When I didn’t take all of mine though people congratulated me on my effort. Not one person told me I was making a mistake. In retrospect it certainly was a mistake. Our culture frowns on scheduled rest. Maybe it goes back to the Protestant Work Ethic?

Great read! I think the idea of rest has been mislabeled. Many people think about rest as a long vacation lounging around. I find that the most restorative ‘rest’ is when I’m doing things I’m passionate about. For me, simply being with my wife and boys on a hike, working around the yard all day, or playing golf seem to be the best medicines for me. I enjoy laying on the beach with a good book too, but I find myself getting antsy to get back to things I’m passionate about. To me, rest = passion.